Cause
Working with
asbestos is the major risk factor for mesothelioma.
[6] In the United States, asbestos is the major cause of malignant mesothelioma
[7] and has been considered "indisputably"
[8] associated with the development of mesothelioma. Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a “signal” or “sentinel” tumor.
[9][10][11][12] A history of asbestos exposure exists in most cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (
Thorotrast), and inhalation of other fibrous silicates, such as
erionite. Some studies suggest that simian
virus 40 (
SV40) may act as a
cofactor in the development of mesothelioma. This has been confirmed in animal studies,
[13][14] but studies in humans are inconclusive.
[13][15][16] Asbestos was known in antiquity, but it was not mined and widely used commercially until the late 19th century. Its use greatly increased during
World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the official position of the U.S.
Occupational Safety and Health Administration (OSHA) and the U.S. EPA is that protections and "permissible exposure limits" required by U.S. regulations, while adequate to prevent most asbestos-related non-malignant disease, they are
not adequate to prevent or protect against asbestos-related cancers such as mesothelioma.
[17] Likewise, the British Government's
Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE assumes that no such "safe" threshold exists. Others have noted as well that there is no evidence of a threshold level below which there is no risk of mesothelioma.
[18] There appears to be a linear, dose-response relationship, with increasing dose producing increasing disease.
[19] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.
[8] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.
[8] Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.
The duration of exposure to asbestos causing mesothelioma can be short. For example, cases of mesothelioma have been documented with only 1–3 months of exposure.
[20][21] People who work with asbestos wear personal protective equipment to lower their risk of exposure.
Latency, the time from first exposure to manifestation of disease, is prolonged in the case of mesothelioma. It is virtually never less than fifteen years and peaks at 30–40 years.
[8] In a review of occupationally related mesothelioma cases, the median latency was 32 years.
[22] Based upon the data from Peto
et al., the risk of mesothelioma appears to increase to the third or fourth power from first exposure.
[19]
